| Introduction:Postoperative pain is usually underestimated and undertreated. It is reported that acute surgical pain occurs in as many as 80% of surgical patients, with up to 86% of these patients experiencing moderate to severe pain. Surgical-induced nociception can induce the change of neuronal activity and neurogenic inflammation, thus may involve in the development of postoperative cognitive dysfunction. It is necessary to get more supra-spinal brain mechanisms of the pathophysiology of surgical induced nociception. The fluorinated D-glucose analog,18F-2-fluoro-2-deoxy-D-glucose (18F-FDG), is the most common radiopharmaceutical for positron emission tomography (PET) imaging and can be used for the assessment of glucose metabolism in the brain.Methods:Pain behavior evaluationTwenty-four rats were randomly divided into three groups (n=8 each) to evaluate the pain behaviors. Right plantar incisions were performed in group 1A. Right plantar incisions after ropivacaine sciatic nerve block were performed in group 1B. Rats in group 1C received no treatment as naive control. Pain behaviors were evaluated on day 1-3 preoperatively, postoperative hour 1,4,12, and postoperative day (POD) 1,2,3,5,7. The thresholds on day 1-3 preoperatively were averaged as the baseline threshold.18 F-FDG PET scanSurgical induced brain glucose metabolism changes:Preoperative brain 18F-FDG PET scans of twelve rats were acquired one day before surgery. Then these twelve rats were randomly divided into two groups(n=6 each):in group 2A, right plantar incision was performed immediately after the administration of 18F-FDG; in group 2B, right sciatic nerve block was implemented about 8 min before the administration of 18F-FDG and plantar incision. Brain PET images were acquired 50 min after i.p. administration of 18F-FDG.Postoperative brain glucose metabolism changes:Preoperative brain 18F-FDG PET scans of sixteen rats were acquired one day before surgery. Then these sixteen rats were randomly divided into two groups (n=8 each):in group 3A, right plantar incision was performed under isoflurane anesthesia; in group 3B, right plantar incision was performed after the implementation and onset of right sciatic nerve block.18F-FDG PET scans were obtained on POD 1,3,6,9,15, and 21.Results:Paw withdrawal mechanical threshold was significantly decreased at postoperative hour 1, hour 4, hour 12, on POD 1 and 2 after plantar incision (all p<0.01). Paw withdrawal thermal latency was significantly decreased at postoperative hour 1(p<0.01), hour 4(p< 0.01), hour 12(p<0.01), POD 1 and 2 (p<0.01),POD 3(p<0.05). Ropivacaine sciatic nerve block can alleviate postoperative mechanical allodynia within 4 h postoperatively (P<0.05)Plantar incision induced nociception can lead to the change of brain metabolic activity. Compared with the metabolic activity preoperatively, plantar incision induced increased cerebral glucose metabolism in contralateral inferior colliculus, cerebellum, medulla oblongata, ipsilateral cerebellum at postoperative hour 1. Compared with the brain metabolic activity in plantar incision, sciatic nerve block with ropivacaine can alleviate the glucose metabolism in cerebellum, midbrain and medulla oblongata.Plantar incision induced increased cerebral glucose metabolism in classic pain related regions such as bilateral insular cortex and ipsilateral CA3 on POD 1 and contralateral insular cortex on POD 3, ipsilateral primary somatosensory cortex and thalamus on POD 6, bilateral thalamus and cerebellum on POD 9 and ipsilateral thalamus and bilateral cerebellum on POD 21. The glucose metabolism in cingulate cortex was decreased on POD 1 and 9. The glucose metabolism in prefrontal cortex and CA1 was decreased on POD 21. Sciatic nerve block with ropivacaine can alleviate the glucose metabolism in insula cortex, caudate putamen, CA3 after plantar incision.Conclusions:Surgery induced nociception can induce the metabolic activity change in pain matrix and cognition related brain regions, activate cerebellum, insula, caudate putamen et al. Sciatic nerve block with ropivacaine is an effective method to alleviate surgery-induced pain in the early stage and surgery-induced brain responses can be attenuated by partially suppressing cerebral glucose metabolism.Introduction:The incidence of drug hypersensitivity reactions during anesthesia can be as high as 1:385. Symptoms may start and grow worse rapidly or even lead to death. It is reported that the mortality of drug hypersensitivity reactions during anesthesia varies from 3% to 9.2%. When drug hypersensitivity reactions happen, quick and effective treatment is very important and subsequent allergen detection is necessary for second operation. With allergen detection, second usage of culprit drug can be avoided and the risk of repeated drug hypersensitivity reaction is reduced. The probability of receiving surgery is also increasing in an ageing society today.In our study, patients with a history of suspected allergic reaction during general anesthesia or local anesthesia, or with a higher risk of anesthetic allergy due to previous anaphylaxis to food or medicine are enrolled in the study for intradermal skin test and/or basophil activation test of anesthetics. Combining the test results and medical history, the culprit drug is determined and epidemiological data for perioperative drug hypersensitivity reactions is obtained for patients undergoing successful second surgery.Methods:From September,2009 to January,2016,96 patients with a history of suspected allergic reaction during of general anesthesia or local anesthesia, or with possible higher risk of anesthetic allergy due to previous anaphylaxis to food or medicine were enrolled. Intradermal skin test and/or basophil activation test were performed. Diagnosis of an allergic reaction was established combining medical history and the result of intradermal skin test as well as basophil activation test.Results:In the study, the number of patients with a history of suspected allergic reaction during general anesthesia is 39 and the number of patients under local anesthesia is 42. The number of patients with possible higher risk of anesthetic allergy due to previous anaphylaxis to food or medicine is 15.Allergic reactions occurred in 36 patients with a history of suspected allergic reaction during general anesthesia or local anesthesia, including 23 women and 13 men. The ratio of women to men was 1.8.31 patients were under general anesthesia and 5 patients were under local anesthesia. Two patients were diagnosed to be allergic to two culprit drugs. So, the number of allergic reactions is 33. One patient was diagnosed to be allergic to both sufentanil and gelatin. The culprit drugs and the number of allergic reactions are listed as follows:antibiotics (n=8), neuromuscular blocking agents (n=7), midazolam (n=5), propofol (n=3), etomidate (n=1), sufentanil (n=3), diazepam (n=1), lidocaine (n=1), gelatin (n=3). Two patients failed for detection of culprit drugs. As to local anesthesia,3 patients were allergic to lidocaine,2 patients were allergic to ropivacaine and 1 patient was allergic to both articaine and lidocaine.38 patients underwent surgeries successfully, among which 20 patients with a history of suspected allergic reaction during general anesthesia,11 patients with a history of suspected allergic reaction during local anesthesia and 7 patients with medical history of previous anaphylaxis to food or medicine.Conclusions:In the perioperative allergic reactions, the ratio of women to men is 1.8.78.8% cases occurred in the stage of induction,91% cases manifested with cardiovascular symptoms. The most common agents for intraoperative allergy are antibiotics and neuromuscular blocking agents. |
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